This poster presents prospective clinical results with the SAPROF and shows it\'s value for use in forensic clinical practice.

1. Protective factors for violent behavior:
Clinical results with the SAPROF
Michiel de Vries Robbé & Vivienne de Vogel, Van der Hoeven Kliniek, Utrecht, The Netherlands
The SAPROF The present study
The Structured Assessment of PROtective Factors for violence risk (SAPROF) is This study presents prospective clinical findings on the predictive validity of the
a checklist for the assessment of protective factors for violent behavior. The protective factors in the SAPROF for a sample of 245 assessments of male
SAPROF was developed as a positive, dynamic and treatment focused offenders (148 violent and 97 sexual). The study was carried out at the Van der
assessment tool, intended to complement and counterbalance commonly used Hoeven Kliniek in The Netherlands, an inpatient forensic psychiatric hospital.
risk assessment instruments in forensic psychiatry. Following the SPJ approach, The SAPROF, the HCR-20 and the PCL-R were scored for all offenders during
the SAPROF is designed to be used in combination with SPJ risk instruments clinical forensic psychiatric treatment. Follow-up data collected over a 12 month
like the HCR-20. period following the assessment concerned violent incidents during treatment
including both physical violence and severe threats.
Advantages
The addition of protective factors creates a more balanced risk assessment for Assessments in Consensus
future violence risk, enabling a more positive approach to (sexual) violence All assessments were carried out in multidisciplinary consensus meetings
prevention. The SAPROF aims to contribute to an increasingly accurate and involving a sociotherapist, treatment supervisor and researcher. For 47 cases
well-rounded assessment of risk for future violent behavior. Moreover, the the individual scores of the three raters were also available, which made
dynamic positive approach of protective factors aims to create new opportunities comparison possible between the predictive accuracies of the individual raters
for effective and achievable treatment interventions. and consensus scores for the assessments (HCR-SAPROF scores ICC = .80).
Translations Different stages of treatment
The SAPROF is now available in Dutch, English, German, Italian, Spanish, Average treatment length at the Van der Hoeven Kliniek is about 6 years. During
French, Swedish and Norwegian. Portuguese, Russian and Danish translations this time patients move through four different treatment stages: Intramural,
are in preparation. Supervised leaves, Unsupervised leaves and Community supervision. Average
SAPROF scores and incidents at the different stages are compared.
Results: Predictive validity Results: The value of Consensus The SAPROF factors
Internal factors
Follow-up (N=245) violent sexual total 1. Intelligence
Sociotherapist 2. Secure attachment childhood
3. Empathy
.70 4. Coping
Total score SAPROF .77 .81 .78 5. Self-control
Motivational factors
Total score HCR-20 .74 .85 .79 6. Work
Results: Changes during clinical treatment 7. Leisure activities
Total HCR-20 – Total SAPROF .81 .84 .82 8. Financial management
9. Motivation for treatment
SAPROF violent AUC Consensus
10. Attitudes towards authority
Final Protection Judgment .69 .73 .70 Treatment phase .84
total (M) incidents SAPROF 11. Life goals
12. Medication
Integrative Final Risk Judgment .75 .81 .77 Treatment Researcher
Inpatient 13 29% .65 Supervisor External factors
(N=34)
.74 .75 13. Social network
Predictive validity (AUC-values) for violent incidents during clinical treatment, all p < .05. 14. Intimate relationship
Supervised leave 18 14% .68 15. Professional care
(N=64) Predictive validity SAPROF scores: individual raters and
16. Living circumstances
Results show good predictive validities for violent incidents during clinical Unsupervised leave 19 6% .75 consensus from multidisciplinary risk assessment (AUC-values)
for violent incidents during clinical treatment (N=47). 17. Supervision
treatment for the SAPROF and the combined HCR-SAPROF. This was true for (N=48)
violent as well as sexual offenders. Overall, the combination of HCR- Community supervision 20 4% .80 Although the SAPROF total scores of the different individual raters each
(N=99)
SAPROF was the best predictor for future violence and provided better demonstrated fairly good predictive validity, the Consensus SAPROF total
predictions than either the SAPROF or the HCR-20 alone. The best individual Mean SAPROF scores, incident rates and predictive validity at different treatment stages. score was by far the best predictor of violence in the year following the
predicting factors differed for both groups: Violent offenders: Self-control, assessment. This finding provides further evidence for the value of doing risk
The table shows the development of protective factors
Attitudes towards authority, Work, Motivation for treatment and Medication; during treatment and the according decrease in violent assessment in multidisciplinary teams. Moreover, consensus meetings offer a
Sexual offenders: Coping, Leisure activities, Attitudes towards authority and incidents. Results show increasing predictive power of the fruitful opportunity to share clinical views and formulate well-informed risk
Social network. SAPROF as treatment becomes more community focused. management strategies and release decision making.
For more information please contact mdevriesrobbe@hoevenstichting.nl
To order the SAPROF guidelines or download free coding sheets see www.forumeducatief.nl